| Study1. Correlation analysis between inflammatory cytokines and blood stasis in patients with AC IObjectiveObserve the clinical primary symptom, blood stasis hierarchical distribution of acute cerebral infarction(ACI) patients with blood stasis, and relationships between blood stasis and nerve function, atherosclerosis, TOSTA subtype, morbidity, inflammatory cytokines. So as to explore the correlation between blood stasis and cerebral infarction by multi level and multi angle, and explore material base of inflammatory cytokines which related to blood stasis in ACI patients.Methods167 patients with acute cerebral infarction who treated in neural department of internal medicine in Foshan City Hospital of TCM and 161 healthy outpatients druing 2013 September to 2014 December as the source of study objects. According to the "Stroke Diagnostic Standard (Trial)" (1994), divided patients and healthy outpatients respectively into blood stasis group and non blood stasis group by blood stasis scores, then graded the patient blood stasis group as mild, moderate, severe groups. Collected venous serum of patients after admission. By using sandwich enzyme linked immunosorbent assay(ELISA) to detect IL-lbeta, IL-6, IL-10, TGF-betal, MMP-9, MCP-1, ICAM-1 content, and respectively using chemiluminescence method, immune turbidimetric method, blood cell analyzer method to detect the contents of TNF-α, CRP, WBC. Observe: ① the onset syndrome of ACI and the first main symptom frequency (rate); ② stratification, distribution and integral of ACI patients with blood stasis;③ correlation analysis between blood stasis and neural function(NIHSS score) in ACI patients;④ correlation analysis between blood stasis and degree of atherosclerosis (CIMT, cfPWV) in ACI patients;⑤ ACI patients with blood stasis TOAST subtypes distribution characteristics and morbidity odds ratio(OR) in each subtype caused by blood stasis;⑥ case-control Mantel Haenszel analysis of cerebral infarction incidence relative risk caused by blood stasis based on age stratification; ⑦ multiple linear regression analysis about serum inflammatory factors of ACI patients and blood stasis.Results① Syndrome frequency (incidence) of 167 ACI patients from high to low:blood stasis syndrome(131,78.4%), wind syndrome(109,65.3%), Qi deficiency syndrome(93,56.7%), phlegm syndrome(82,49.1%), heat syndrome (55,32.9%), yin deficiency and yang hyperactivity syndrome(31,18.6%). Hemiplegia, partial body sensory abnormalities, slurring of speech or unable to speak, mouth askew, disturbed consciousness, these five starting main symptoms corresponding to the highest incidence of syndromes were blood stasis(81.68%), Qi deficiency(55.91%), blood stasis(35.88%), wind(58.72%), phlegm(7.32%).② The blood stasis scores of the ACI patients with non blood stasis, mild blood stasis, moderate blood stasis and severe blood stasis were 3.22±1.742,10.42 ± 2.084,18.30+2.188,25.89 ± 2.115. With gradual deepening of degree of blood stasis, the blood stasis scores were significantly increased(P<0.01).③ The degree of blood stasis (integral) and neurological function injury (NIHSS score) in ACI patients were positively correlated (Pearson correlation coefficient 0.909, P<0.01).④ Blood stasis stratification and classification of CIMT were positively correlated(Spearman’s rank correlation coefficient 0.387, P< 0.01);no significant difference between non blood stasis group and mild blood stasis group in cfPWV(P> 0.05), the two groups have significant differences both with moderate and severe blood stasis group-in cfPWV(P> 0.05),and there was significant difference between moderate and severe blood stasis group in cfPWV(P<0.01).⑤ The possibility of people with blood stasis suffer from LAA type cerebral infarction is 2.926 times than that of non blood stasis ones(P< 0.05), whereas suffer from SAA type cerebral infarction is 2.696 times than that of non blood stasis ones(P<0.05).⑥ The risk of people with blood.stasis for suffering from cerebral infarction is 5.931 times than that of non blood stasis ones(P<0.05).⑦ There was multiple linear correlation between blood stasis integral and content of serum CRP, TNF-α, IL-6, IL-1β as well as IL-10. Regression coefficients were 0.460,0.825,1.867,0.116,-1.19 respectively, the constant term was-8.944.Conclusion① Blood stasis is the most common TCM syndrome types of ACI patients. The incidence of its two starting main symptoms like hemiplegia and slurring of speech or unable to speak, are the highest ones in all symptom types of ACI patients.② With aggravation of blood stasis, the neurological function damage and the degree of atherosclerosis in patients with ACI gradually increased.③ People with blood stasis have significantly higher risk for suffering from LAA or SAA subtypes of cerebral infarction than those non blood stasis ones.④ People with blood stasis have significantly higher risk for suffering from cerebral infarction than those non blood stasis ones.⑤ The degree of blood stasis in patients with ACI and content of serum CRP, TNF-α, IL-6, IL-1β as well as IL-10 showed multiple linear correlation. In the case of other variables are unchanged, the higher content of CRP, TNF-α, IL-6 and IL-1β, or the lower content of IL-10, the heavier degree of blood stasis. The factors above may be the material basis of inflammatory cytokines which correlate with blood stasis.Study2. Influence of Huo Xue granule to inflammatory cytokines and blood stasis in ACI patientsObjectiveBy using Huo Xue granules which has the effect of promoting blood circulation for removing blood stasis to treat ACI patients with blood stasis, then observed its effects on the correlated serum inflammatory cytokines, blood stasis, nerve function and relationship among them, so as to investigate the therapeutic effect and possible inflammatory mechanism of Huo Xue granule in treatmenting ACI.Methods128 patients with acute cerebral infarction who treated in neural department of internal medicine in Foshan City Hospital of TCM druing 2013 September to 2014 December as the source of study objects. Randomly divided the patients into 65 cases in the control group(5 cases lost or eliminated),63 cases in the treatment group(3 cases lost or eliminated). Another 60 healthy persons were selected as normal group. The control group was given basic treatment of Western Medicine, whereas based on basic treatment of Western Medicine, the treatment group was added Huo Xue granules,1 bag/time,3 times/day, boiled water. After admission, collect elbow vein blood before treatment for detecting content of serum CRP, IL-1 β , IL-6, IL-10, TNF-α, and evaluate the blood stasis score and NIHSS score.In seventh and fourteenth days, retest all the indicators above. Then observe:① influence of Huo Xue granules on the correlated serum inflammatory cytokines in ACI patients with blood stasis;②ffect of Huo Xue granules on blood stasis integral in patients with blood stasis;③ effect of Huo Xue granules on nerve function in patients with blood stasis;④correlation analysis of nerve function NIHSS score, content of serum inflammatory cytokines which correlate with blood stasis and blood stasis score, and the investigation of inflammatory mechanism on Huo Xue granules treating ACI patients with blood stasis.Results①There was no significant difference on content of serum CRP and IL-6 between treatment group and control group before treatment (P> 0.05), they were significantly higher than that in normal group (P< 0.01). On the 7th day and 14th day, CRP and IL-6 levels of two groups declined, there was no significant difference(P> 0.05). No interaction between time factors and grouping factors;There was no significant difference on content of serum IL-1β and TNF-α between treatment group and control group before treatment(P>0.05), they were significantly higher than that in normal group(P<0.01). On the 7th day and 14th day, IL-1β and TNF-α levels of two groups declined, the treatment group was significantly lower than that of control group(P<0.01). There was interaction between time factor and grouping factors;There was no significant difference on content of serum IL-10 between treatment group and control group before treatment (P> 0.05), they were significantly higher than that in normal group(P<0.01). On the 7th day, the content of IL-10 in the two groups was increased, and treatment group was significantly higher than that of the control group(P<0.01). On the 14th day, the content of IL-10 in the two groups was decreased relative to the 7th day, and treatment group was significantly higher than that of the control group(P< 0.01). There was interaction between time factor and grouping factors.② There was no significant difference on blood stasis integral between treatment group and control group before treatment(P> 0.05). On the 7th day, the blood stasis integral of treatment group was significantly lower than that before treatment(P< 0.01), whereas the control group after treatment had no significant difference (P>0.05), and there was significant difference between the two groups;On the 14th day, blood stasis integral of the two groups were significantly decreased compared to the 7th day (treatment group P< 0.01, control group P<0.05) and pretherapy(P< 0.01), and there was significant difference between the two groups (P<0.01)③ There was no significant difference on NIHSS score between treatment group and control group before treatment(P> 0.05). On the 7th day, NIHSS scores of the two groups were both significantly lower than that of before treatment(P>0.05), and there was no significant difference between the two groups (P> 0.05); On the 14th day, NIHSS scores of the two groups were both significantly lower than that of the 7th day (treatment group P<0.01, control group P<0.05) and pretherapy(P<0.01), and there was significant difference between the two groups (P<0.01)④ There was multiple linear correlation between blood stasis integral and NIHSS scores (regression coefficients was 0.899). There has no multiple linear correlation between NIHSS score and content of serum IL-1 β,IL-10 and TNF-α.Gonelusion① For ACI patients, Huo Xue granules has the effect of raising expression of serum IL-10 and cutting expression of serum IL-1β and TNF-a,while no significant effect on CRP, IL-6 expression.② Huo Xue granules can reduce ACI patients with blood stasis integral and NIHSS score, and has the curative effect to improve the degree of blood stasis and neural function.③ The effect of Huo Xue granules on improving the degree of blood stasis and neural function, may relate to the mechanism that it could raise expression of serum IL-10 and cut expression of serum IL-1β and TNF-a in the acute stage of ACI patients. |
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